Fiance referred to urologist over psa

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  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,729 Member
    ANWANK said:

    Operative report

    Ok so obviously the biopsy results are not back yet but I did get the operative report. It says that his prostate volume is 58.8 and englarged in transitional zone. Which seems to me he would probably just have bph then? They took 12 cores. It does say his prostate health index score is 69 which I know is not good at all. But if he has bph, I would imagine that would effect this score?

    Both

    Anwank,

    MOST men over 50 have BPH/BEP.  The symptoms of BPH are mostly IDENTICAL to PCa.  Hence, the presence of BPH in any given man is no evidence for or against PCa.  You will know the answer within a few days however.

    max

  • VascodaGama
    VascodaGama Member Posts: 3,501 Member
    Checking for probabilities

    The probability of existing cancer in terms of an index above 36 (PHI) is greater. Surely any effect influencing the values of the PSA would affect the PHI. However, this index is just checking for probabilities in having cancer when comparing with the average values from a series of PHI trials involving the results of numerous cases. The biopsy is still the way to diagnose existing cancer.

    Let us know the final results.

    Best,

    VG

     

  • ANWANK
    ANWANK Member Posts: 13
    Biopsy results. Treatment Options?

    His results came in today and we were told it is cancer. So now we go Monday to discuss treatment. A brief history. He is 45. His father and brother both had this cancer at young ages in their 40's and 50's. I have read that if u have an enlarged prostate you are not a good candidate for radiation. Is this true? And I also read that if u have radiation it can complicate it if you end up needed the surgery later. At his age, is he even a good candiate for AS? I do not have the pathology report but will get it Monday. Dr just said 3 cores were positive and it is Gleason 6. Thank you anyone for advice and for what we need to be asking the dr Monday.

  • Old Salt
    Old Salt Member Posts: 910 Member
    ANWANK said:

    Biopsy results. Treatment Options?

    His results came in today and we were told it is cancer. So now we go Monday to discuss treatment. A brief history. He is 45. His father and brother both had this cancer at young ages in their 40's and 50's. I have read that if u have an enlarged prostate you are not a good candidate for radiation. Is this true? And I also read that if u have radiation it can complicate it if you end up needed the surgery later. At his age, is he even a good candiate for AS? I do not have the pathology report but will get it Monday. Dr just said 3 cores were positive and it is Gleason 6. Thank you anyone for advice and for what we need to be asking the dr Monday.

    Some tentative answers

     I have read that if u have an enlarged prostate you are not a good candidate for radiation. Is this true?

    Not generally (!) true

     

    And I also read that if u have radiation it can complicate it if you end up needed the surgery later.

    Very few surgeons are qualified to do surgery after radiation. But there are many treatment options if radiation fails.

    At his age, is he even a good candiate for AS? I do not have the pathology report but will get it Monday. Dr just said 3 cores were positive and it is Gleason 6. 

    We need more info; where are the cancers located? All on one side (lobe) and how close to the margin are important factors to consider. Please get advice from an AS specialist. Note that this is a rather 'personal' decision as well. Some patients are not 'designed' for AS protocols because they would worry too much.

  • VascodaGama
    VascodaGama Member Posts: 3,501 Member
    Do not rush into a decision without securing due information

    ANWANK

    I am sorry for the results of the biopsy but you do understand that this diagnosis relieves you both from the anguish of probabilities in confronting this hereditary disease. A negative biopsy would always be questionable. I would like to know more details on the results but 3 cores with Gleason score 6 is good news. The next step will involve exams to locate the bandit. This is traditionally obtained with CT and Bone scans. However, I would prefer to get those images with a 3tMRI or the sophisticated PET/CT which is presently the most recommended exam in PCa diagnosis. After that, his doctor will provide a Clinical Stage with which a treatment can be planned.

    In this regard, you better wait for his doctor's opinion, do some researches, get second opinions from several other specialists and discuss with the whole family before deciding on an option. In my opinion, for a man of 45 yo, Active Surveillance is the best if appropriate in his status. The quality of life is in jeopardy and he is too young to risk permanent effects from radical treatments. In any case he should think to treat if the bandit shows to be aggressive.

    I agree with Old Salt's opinions above. Without a due clinical stage obtained from reliable due exams nobody should decide on a treatment. You need to advance in this journey without rushing. Move coordinately and timely but do not sleep on the matter.

    Each case is unique of the holder and should not be paired with others. What works for one may not do well for another. His father and brother hereditary history should not be taken as the way to follow but simple as reference examples. While waiting, I would recommend you to get additional tests that may influence treatments. For instance; a colonoscopy to look for any asymptomatic ulcerative colitis. A DEXA scan for bone health and a full lipids account.

    Here are some links to help you understanding the matters of PCa. You should prepare in advance a list of questions for the doctors you are metting;

    A practical guide to prostate cancer diagnosis and management;
    http://www.ccjm.org/index.php?id=105745&tx_ttnews%5Btt_news%5D=365457&cHash=b0ba623513502d3944c80bc1935e0958

    Prostate Cancer Staging;
    http://emedicine.medscape.com/article/2007051-overview

    List of Questions;
    http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

    Books;
    https://csn.cancer.org/node/311252

     

    Please note that we are not doctors. Our opinions are based on own experience and researches done along our journey as survivors.

    Best wishes and luck in his journey.

    VGama

  • Tech70
    Tech70 Member Posts: 70 Member
    Oncotype score

    would be very helpful in deciding what course of treatment he might want to follow.  It's accepted by Medicare, but at his young age, you might want to check with his insurance company.  Medicare was billed $4520 and they paid around $3100 in my case.  I think Genomic Health (the company that does Oncotype DX test) has a program of financial assistance for those whose insurance won't cover the test.

  • Coldbiker
    Coldbiker Member Posts: 23
    edited February 2018 #28
    Some are suggesting expensive

    Some are suggesting expensive testing, he Is young, family history, had positive biopsy not bad now. Surgery side effects are immediate and tend to get better but not always, tougher on younger men, radiation some effects during and after tend to get worse as time goes by. Doctors tend to bottom line it . Surgery it’s gone might come back years later, many men choose that. Radiation takes awhile to know the results. AS really delays the decisions and treatment as long as everything stays stable. I’m an outlier PSA 1.5 for years, at age 62 a lump  had a biopsy because my family doctor is proactive. Gleason 6 5 out of 12 cores. AS 5 years. three biopsy’s later psa still under 2.8 7 cores 6 1 core 7 4+3 1 core small 8 4+4. 20 20 hindsight should I have skipped AS, urologist says he wouldn’t have recommended surgery and is at a loss as why the quick progression. My prostate is small so no BPH. Treatment decisions haven’t changed much hormone therapy added to mix,  just happening now.

  • ANWANK
    ANWANK Member Posts: 13
    edited February 2018 #29
    pathology report

    As previously stated, he has decided to go with the Da Vinci surgery. Met with Dr today and will be having it in 6 weeks. Did get a copy of pathology report. Here is a rundown of it

     

     

    Left Lateral base: Benign prostatic tissue

    Left Lateral Mid:Benign prostatic tissue

    Left Lateral Apex: Prostatic Adenocarcinoma, Gleason score 6 (3+3) 1 of 1 core positive 12%

    Left Medial Base:Benign prostatic tissue

    Left Medial Mid: Focal High Grade PIN

    Left Medial Apex: Benign prostatic tissue

    Right Medial Base: Benign prostatic tissue

    Right Medial Mid: Benign prostatic tissue

    Right Medial Apex: Prostatic Anenocarcinoma Gleason score 6 (3+3) 1 of 1 core 17%

    Right Lateral Base: Microscopic focus of Atypical glands

    Right Lateral Mid: Benign prostatic tissue

    Right Lateral Apex: Prostatic Adenocarcinoma, Gleason score 6 (3+3) 1 of 1 core positive 4%

    Comment: Immunoperoxidase stains including antibodies to basal cells (p63 and high molecular weight cyokeratin) and P504S (a marker preferentially expressed in prostate cancer) were used to confirm the diagnosis in the core from the left lateral apex. They atypical glands lack a stainable basal cell layer and display glanular cytoplasmic positivity for P504S, supporting the diagnosis of adenocarcinoma.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    Prostate cancer is very slow growing.

    Good idea to interview various treatment specialists to receive input.

    There is a difference among surgeons, and successful outcome. Interview more than one.

    There is an image test, 3T MRI that may indicate if there is extracapsular extension, that is if the cancer has escaped the capsule (which in this case is not likely, but still very improtant to have). This would affect treatment choice.

  • VascodaGama
    VascodaGama Member Posts: 3,501 Member
    Have you received a Clinical Stage?

    At 45 years old no one is suspected of having bone metastases, so that the info in above report would lead to think that he has a contained case. In such regard surgery or radiation are options that may eliminate the bandit for good. Among the typical risks in Robot surgery are Erection Dysfunction and Incontinence. One also looses the possibility in fathering a child again (banking sperm is recommended). Radiation treatment is linked with the risks of Colitis and Urethritis (scar tissue). It also affects the seminal vesicles to a certain extent (sperm).

    I agree with Hopeful's above comment that an additional image exam will provide a better clinical stage. It is important to your husband to know the risks involved in the treatment of choice so that he can evaluate the situation before committing.

    Best wishes for the best outcome.

    VG

  • ANWANK
    ANWANK Member Posts: 13
    Clinical stage

    Dr said it was T1C, I believe. My guy is completely against radiation. He did not even want to meet with the radiation oncologist. He says he would rather have the surgery and be done with it and doesn't want to take the chance of getting radiation, it coming back, then having to find a surgeon to do the surgery on a radiated prostate and not be able to have the nerve sparing surgery. We do have the best urologist in our city. He is the chief of urology at several hospitals here and was the first to perform the Da Vinci here. He has been doing them for 14 years in our area now. I definitely checked on that! So I feel like he is in good hands. The doctor has a great bedside manner and spent over an hour with us yesterday just talking and giving him all his options. He was very upfront about the risks with the surgery and how it would change things. He is sending my fiance to biofeedback to learn to do certain exercises for urinary control and said he would be prescribing cialis and a vacuum pump. Anything else I should know about this surgery beforehand so I can help prepare him?

  • ANWANK
    ANWANK Member Posts: 13

        

     My story:67 year old male; PSA 4.72 increasing over the last 3 years; Digital Rectal Exam, prostate is not swollen; father had prostate cancer elected removal (the cancer did not cause his passing); I requested a 3T MRI prior to biopsy; MRI indicated 2 lesions one a PIRAD 5 and one a PIRAD 4; biopsy confimred prostate cancer in the PIRAD 5 lesion; PIRAD 4 no cancer. Urologists recommends: Prostate removal with pelvic lymph node dissection.  I am looking at an experienced urologists who only does robotic guided prostate removal now (over 1,000 procedures).  He did offer hormone and radiation but did not think that was the best route due to tumor and it being only in the left apex of the prostate.  I feel very comfortable with this surgeon.  My wife and I decided on the removal of the prostate and lymph node dissection procedure.  On the lighter side, during our interview the surgeon did ask us did we have sex.  My wife did not say anything, I told him everytime I can catch her, but she is very fast.  Anyway go to preop March 5 and surgery on March 20.  Gleason 4+3=7.



     



     




     



    Welcome

    Very sorry that you have been diagnosed. I am new to this forum as well and it has been a wealth of information. I feel like I have learned so much here. I am not sure if you meant to post on the main board instead of in reply to my post but that is ok. And u sound like my fiancee, he would have definitely said something like that about catching me!

  • Tdoyle
    Tdoyle Member Posts: 36
    edited February 2018 #34
    opinions

    I am fairly new here and my diagnosis is very similiar to his.  I am still learning and taking in all the great advise the great people on this site have to offer. I had the MRI T3 last week, which is a good test to see if everything is contained. In my case it was and my last psa was 5.23 and I am 53 years old. I have been on a rollercoaster ride since I found out about the cancer, doctors in the town I live in did test and i was diagnoised having  mets to bone. Talk about scared. I went for 2nd opinion to UAMS cancer institute and had more test run and here I am.  I have decided to go with AS for the time being and hopefully I can continue this for a long time, the thoughts of surgery and the possible side effects scare me....This is just my 2 cents and not trying to change any decisions anyone has made...Like these knowledgeable people always say it is his decision and what ever it is, it will be the right one for him.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    lighterwood

    Please start a new thread.

    Click discussion boards above, and then click "add new forum topic" in upper left corner, found under "Discussion Boards"

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,729 Member
    ANWANK said:

    Clinical stage

    Dr said it was T1C, I believe. My guy is completely against radiation. He did not even want to meet with the radiation oncologist. He says he would rather have the surgery and be done with it and doesn't want to take the chance of getting radiation, it coming back, then having to find a surgeon to do the surgery on a radiated prostate and not be able to have the nerve sparing surgery. We do have the best urologist in our city. He is the chief of urology at several hospitals here and was the first to perform the Da Vinci here. He has been doing them for 14 years in our area now. I definitely checked on that! So I feel like he is in good hands. The doctor has a great bedside manner and spent over an hour with us yesterday just talking and giving him all his options. He was very upfront about the risks with the surgery and how it would change things. He is sending my fiance to biofeedback to learn to do certain exercises for urinary control and said he would be prescribing cialis and a vacuum pump. Anything else I should know about this surgery beforehand so I can help prepare him?

    Informed

     

    Anwank it soulds like your "guy" has become well informed in a brief amount of time.  It is good that his surgeon shared all likely effects of surgery in detail beforehand.  The biofeedback is very likely kegel exercises, that will quicken urinary control post-op.

    It is curious that he repudiated radiation without ever even speaking to a rad oncologist, but he is his own man, with his own reasons.  Be aware that under-estimation of Staging is fairly common, whereas over-estimating virtually never happens.

    Best of luck to the both of you,

    max

  • lighterwood67
    lighterwood67 Member Posts: 324 Member
    edited February 2018 #37

    lighterwood

    Please start a new thread.

    Click discussion boards above, and then click "add new forum topic" in upper left corner, found under "Discussion Boards"

    Ok. 

  • lighterwood67
    lighterwood67 Member Posts: 324 Member
        

     My story:67 year old male; PSA 4.72 increasing over the last 3 years; Digital Rectal Exam, prostate is not swollen; father had prostate cancer elected removal (the cancer did not cause his passing); I requested a 3T MRI prior to biopsy; MRI indicated 2 lesions one a PIRAD 5 and one a PIRAD 4; biopsy confimred prostate cancer in the PIRAD 5 lesion; PIRAD 4 no cancer. Urologists recommends: Prostate removal with pelvic lymph node dissection.  I am looking at an experienced urologists who only does robotic guided prostate removal now (over 1,000 procedures).  He did offer hormone and radiation but did not think that was the best route due to tumor and it being only in the left apex of the prostate.  I feel very comfortable with this surgeon.  My wife and I decided on the removal of the prostate and lymph node dissection procedure.  On the lighter side, during our interview the surgeon did ask us did we have sex.  My wife did not say anything, I told him everytime I can catch her, but she is very fast.  Anyway go to preop March 5 and surgery on March 20.  Gleason 4+3=7.



     



     




     



  • VascodaGama
    VascodaGama Member Posts: 3,501 Member
    Additional considerations for after op

    ANW,

    Trusting the doctor caring our case is a good step for a successful therapy. There will be a catheter with attached bag for urination during 10 days. This is most uncomfortable when we move but I recommend your man to try walking everyday two times about 400 meters for better healing and discharge of accumulated liquids and gases. There will be pain so that he should request pills from his doctor before leaving the hospital. Max above is talking about kegels which will activate the muscles that help controlling incontinence but I would start them after allowing the area to heal proper.

    The PSA will be the test to follow after op and I would recommend it to be done at the same laboratory in assays with two decimal digits (0.XX ng/ml). The first PSA (after op) should be lower than 0.06 ng/ml at one month and it should be maintained thereafter. This value is indicative of surgery success and after 6 months it confirms remission. Cure is never mentioned by physicians but one may believe in it if remission lasts 5 years.

    Best,

    VG